Efficacy of Trigger Point Injections in Patients with Lumbar Disc Hernia without Indication for Surgery

Bahar Dernek, Levent Adiyeke, Tahir Mutlu Duymus, Akın Gokcedag, Fatma Nur Kesiktas, Cihan Aksoy, Bahar Dernek, Levent Adiyeke, Tahir Mutlu Duymus, Akın Gokcedag, Fatma Nur Kesiktas, Cihan Aksoy

Abstract

Study design: Prospective comparative study.

Purpose: To investigate the efficacy of gluteal trigger point (TP) injections with prilocaine in patients with lumbosacral radiculopathy complaining of gluteal pain.

Overview of literature: TP injections can be performed using several anesthetic agents, primarily lidocaine and prilocaine. While several studies have used lidocaine, few have used prilocaine.

Methods: A total of 65 patients who presented at the polyclinic with complaints of lower back pain with lumbar disc herniation (based on physical examination and magnetic resonance imaging) and TPs in the gluteal region were included in this prospective comparative study. Group 1 comprised 30 patients who were given TP injections, a home exercise program, and oral medications, and group 2 comprised 35 patients who were only treated with a home exercise program and oral medications. The patients' demographic data, Oswestry Disability Index (ODI) scores, and Visual Analog Scale (VAS) scores were recorded, and these data were evaluated at 1- and 3-month follow-ups.

Results: The ODI and VAS scores of both groups significantly decreased initially and at the follow-up examinations, but the decreases were more marked in group 1.

Conclusions: We obtained better results with TP injections than only a home exercise program and oral medications in patients with radiculopathy and TPs in the gluteal region.

Keywords: Injection; Lumbar disc disease; Trigger point.

Conflict of interest statement

Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1. Visual Analog Scale scores of…
Fig. 1. Visual Analog Scale scores of the two groups.
Fig. 2. ry Disability Index scores of…
Fig. 2. ry Disability Index scores of the two groups.

References

    1. Guo W, Zhao P, Zhou W, et al. Correlation studies between MRI and the symptom scores of patients with LDH before and after manipulative therapy. Zhongguo Gu Shang. 2010;23:17–19.
    1. Bratt JM, Franzi LM, Linderholm AL, O'Roark EM, Kenyon NJ, Last JA. Arginase inhibition in airways from normal and nitric oxide synthase 2-knockout mice exposed to ovalbumin. Toxicol Appl Pharmacol. 2010;242:1–8.
    1. Sari H, Akarirmak U, Uludag M. Active myofascial trigger points might be more frequent in patients with cervical radiculopathy. Eur J Phys Rehabil Med. 2012;48:237–244.
    1. Travell J, Simons D. General issues. In: Travell J, Simons D, editors. Myofascial pain and dysfunction: the trigger point manual: vol. 2, the lower extremities. Baltimore (MD): Lippincott Williams and Wilkins; 1992. pp. 8–22.
    1. Tough EA, White AR, Richards S, Campbell J. Variability of criteria used to diagnose myofascial trigger point pain syndrome: evidence from a review of the literature. Clin J Pain. 2007;23:278–286.
    1. Simons DG, Travell JG, Simons LS. Myofascial pain and dysfunction: the trigger point manual. 2nd ed. Baltimore (MD): Lippincott Williams & Wilkins; 1999.
    1. Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol (1985) 2005;99:1977–1984.
    1. Narvani AA, Tsiridis E, Kendall S, Chaudhuri R, Thomas P. A preliminary report on prevalence of acetabular labrum tears in sports patients with groin pain. Knee Surg Sports Traumatol Arthrosc. 2003;11:403–408.
    1. Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician. 2002;65:653–660.
    1. Kennedy DJ, Noh MY. The role of core stabilization in lumbosacral radiculopathy. Phys Med Rehabil Clin N Am. 2011;22:91–103.
    1. Yakut E, Duger T, Oksuz C, et al. Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine (Phila Pa 1976) 2004;29:581–585.
    1. Adelmanesh F, Jalali A, Jazayeri Shooshtari SM, Raissi GR, Ketabchi SM, Shir Y. Is there an association between lumbosacral radiculopathy and painful gluteal trigger points?: a cross-sectional study. Am J Phys Med Rehabil. 2015;94:784–791.
    1. Cannon DE, Dillingham TR, Miao H, Andary MT, Pezzin LE. Musculoskeletal disorders in referrals for suspected lumbosacral radiculopathy. Am J Phys Med Rehabil. 2007;86:957–961.
    1. Akamatsu FE, Ayres BR, Saleh SO, et al. Trigger points: an anatomical substratum. Biomed Res Int. 2015;2015:623287.
    1. Ramsook RR, Malanga GA. Myofascial low back pain. Curr Pain Headache Rep. 2012;16:423–432.
    1. Partanen JV, Ojala TA, Arokoski JP. Myofascial syndrome and pain: a neurophysiological approach. Pathophysiology. 2010;17:19–28.
    1. Iglesias-Gonzalez JJ, Munoz-Garcia MT, Rodrigues-de-Souza DP, Alburquerque-Sendin F, Fernandez-de-Las-Penas C. Myofascial trigger points, pain, disability, and sleep quality in patients with chronic nonspecific low back pain. Pain Med. 2013;14:1964–1970.
    1. Garvey TA, Marks MR, Wiesel SW. A prospective, randomized, double-blind evaluation of trigger-point injection therapy for low-back pain. Spine (Phila Pa 1976) 1989;14:962–964.
    1. Kamanli A, Kaya A, Ardicoglu O, Ozgocmen S, Zengin FO, Bayik Y. Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. Rheumatol Int. 2005;25:604–611.
    1. McPartland JM. Travell trigger points: molecular and osteopathic perspectives. J Am Osteopath Assoc. 2004;104:244–249.
    1. Cederholm I, Briheim G, Rutberg H, Dahlgren C. Effects of five amino-amide local anaesthetic agents on human polymorphonuclear leukocytes measured by chemiluminescence. Acta Anaesthesiol Scand. 1994;38:704–710.
    1. Eriksson AS, Sinclair R, Cassuto J, Thomsen P. Influence of lidocaine on leukocyte function in the surgical wound. Anesthesiology. 1992;77:74–78.
    1. MacGregor RR, Thorner RE, Wright DM. Lidocaine inhibits granulocyte adherence and prevents granulocyte delivery to inflammatory sites. Blood. 1980;56:203–209.
    1. Sinclair R, Eriksson AS, Gretzer C, Cassuto J, Thomsen P. Inhibitory effects of amide local anaesthetics on stimulus-induced human leukocyte metabolic activation, LTB4 release and IL-1 secretion in vitro. Acta Anaesthesiol Scand. 1993;37:159–165.
    1. Hameroff SR, Crago BR, Blitt CD, Womble J, Kanel J. Comparison of bupivacaine, etidocaine, and saline for trigger-point therapy. Anesth Analg. 1981;60:752–755.
    1. Frost A. Diclofenac versus lidocaine as injection therapy in myofascial pain. Scand J Rheumatol. 1986;15:153–156.
    1. Yuan T, Li Z, Li X, Yu G, Wang N, Yang X. Lidocaine attenuates lipopolysaccharide-induced inflammatory responses in microglia. J Surg Res. 2014;192:150–162.
    1. Tasi WC, Petersen-Jones SM, Huang PY, Lin CT. The neuroprotective effects of lidocaine and methylprednisolone in a rat model of retinal ischemia-reperfusion injury. J Vet Med Sci. 2012;74:307–313.
    1. Staal JB, de Bie R, de Vet HC, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database Syst Rev. 2008;(3):CD001824.

Source: PubMed

3
Subskrybuj